【摘要】： 目的：通過(guò)對(duì)模擬擴(kuò)大經(jīng)鼻-翼腭窩-翼管-Meckel腔入路所涉及結(jié)構(gòu)及毗鄰結(jié)構(gòu)的顯微解剖學(xué)研究,分析對(duì)侵及Meckel腔及翼管等結(jié)構(gòu)的三叉神經(jīng)鞘瘤等疾病術(shù)中入路的可行、可選性以及該手術(shù)入路的利弊。為提高經(jīng)鼻-翼腭窩入路切除鞍旁腫瘤的手術(shù)成功率和安全性提供解剖學(xué)依據(jù)。方法：對(duì)15具成年國(guó)人尸體頭顱標(biāo)本進(jìn)行模擬鼻內(nèi)鏡下沿入路分層顯微解剖,對(duì)相關(guān)解剖標(biāo)志進(jìn)行了觀察、分析、拍攝和測(cè)量。 結(jié)果：該入路分三步：進(jìn)入上頜竇、進(jìn)入翼腭窩、進(jìn)入Meckel腔。尋找蝶腭孔沿翼管追蹤翼管神經(jīng)血管束,解剖分離四方形空間(內(nèi)側(cè)為斜坡旁頸內(nèi)動(dòng)脈,外側(cè)為上頜神經(jīng),上界是外展神經(jīng),下界為頸內(nèi)動(dòng)脈巖部)可安全到達(dá)Meckel腔。鼻小柱至上頜竇口、蝶腭孔、翼管前孔距離分別為(44.08±2.61)mm、(64.83±2.42)mm、(70.43±2.94)mm；鼻小柱至上頜竇口及蝶腭孔連線與腭骨水平板夾角分別為：(38.10±2.46)°、(26.15±2.26)°；蝶腭動(dòng)脈外徑為2.06±0.41(1.91-2.21)mm.翼管動(dòng)脈外徑為1.10±0.33(0.98-1.23)mm；經(jīng)蝶鞍旁神經(jīng)血管關(guān)系由前向后分為：視柱三角(OST)、上三角區(qū)(STA)、上四邊形區(qū)(SQA)、下四邊形區(qū)(IQA)。 結(jié)論：擴(kuò)大經(jīng)鼻-翼腭窩-翼管-Meckel腔入路提供到達(dá)翼管及Meckel腔的前下內(nèi)面的安全直接入路,對(duì)處理翼管及Meckel腔病變是一種可被選擇的入路方式。
[Abstract]:Objective: To analyze the feasibility, selectivity, advantages and disadvantages of the approach for resection of the sella via the nasal-pterygopalatine fossa-pterygopalatine canal-Meckel approach in the treatment of trigeminal neurilemmoma involving the structures of the nasal-pterygopalatine fossa and pterygopalatine canal. Methods: Fifteen adult Chinese cadaveric head specimens were dissected under the simulated nasal endoscope along the approach, and the related anatomical markers were observed, analyzed, photographed and measured.
Results: The approach was divided into three steps: into the maxillary sinus, pterygopalatine fossa, and into the Meckel cavity. The distances of maxillary ostium, sphenopalatine foramen and pterygoid foramen were (44.08 (+ 2.61) mm, (64.83 (+ 2.42) mm, (70.43 (+ 2.94) mm, respectively; the angles between nasal columella and maxillary ostium, sphenopalatine foramen and palatal horizontal plate were (38.10 (+ 2.46), (26.15 (+ 2.26)degrees; the external diameter of sphenopalatine artery was 2.06 (+ 0.41) (1.91 - 2.21) mm. Mm. The parasellar nerve-vessel relationship can be divided from anterior to posterior: optic column triangle (OST), upper triangle (STA), upper quadrilateral area (SQA) and lower quadrilateral area (IQA).
Conclusion: Enlarged transnasal-pterygopalatine fossa-pterygoid canal-Meckel approach provides a safe direct approach to the anterior and inferior interior of the pterygoid canal and Meckel cavity, which is an alternative approach for the treatment of pterygoid canal and Meckel cavity lesions.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R322.8

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